Experience of Laparoscopic Cholecystectomy at Lumbini Medical College Teaching Hospital

  Introduction: The difficult gallbladder is the most common difficult laparoscopy being performed by generalsurgeons all over the world and the potential one that places the patient at significant risk. The present study aimed to study all the cases of laparoscopic cholecystectomy conducted in current setup at Lumbini Medical College and Teaching Hospital, to compare the results with the published literature and also analyze the complications and ways to decrease the incidence of conversion to open procedure.   Methods: Five hundred twenty five patients age 10-90 years, male:female ratio of 1:3.86 with body weight 45-65 kilogram, who had undergone laparoscopic cholecystectomy for symptomatic cholelithiasis without choledocholithiasis from April 2011 to April 2013 were studied.   Results: All the laparoscopic cholecystectomy (LC) were without major complications. Only nineteen out of five hundred twentyfive (3.6%) required conversion to open cholecystectomy (OC). Reasons for conversion included: dense omental or visceral adhesions; two (0.38%), unclear anatomy; 16 (3.04%), common bile duct injury; one (0.19%). There were 20 cases of shrunken gallbladder suspicious of malignancy but didn’t required conversion.   Conclusion: Laparoscopic cholecystectomy is the preferred method in our setup even in difficult cases

Correlation between height and different sections of the sacrotuberous ligament A, B, C, and D.

<p>Correlation between height and different sections of the sacrotuberous ligament A, B, C, and D.</p

Sciatic nerve distances from different divisions of the sacrotuberous ligament A, B, C and D in Beagles and mongrels.

<p><b>Results are expressed as mean±SD.</b> Letters above the bar indicate that these sections differ significantly from each other (a, b, c: <i>P</i><0.05); * indicates the significance between Beagles and mongrels <i>(P</i><0.05).</p

Sciatic nerve distance from different divisions of the sacrotuberous ligament A, B, C and D in small, medium, and large mongrel groups.

<p>Results are expressed as mean±SD. Letters above the bar indicate that these sections differ significantly from each other (*: <i>P</i><0.05).</p

Sciatic nerve distances from different divisions of the sacrotuberous ligament A, B, C and D in 68 cadavers.

<p>Results are expressed as mean±SD. Letters above the bar indicate that these sections differ significantly from each other (a, b, c: <i>P</i><0.05).</p

Correlation and regression between height and distance of the sciatic nerve from C of sacrotuberous ligament.

<p><b>r = 0.64, <i>P</i><0.01.</b> Effect size is larger or larger than the typical.</p

Anatomical landmarks used for locating the left sciatic nerve and the sacrotuberous ligament in a dog.

<p>A line has been drawn to connect the cranial dorsal iliac spine and the ischiatic tuberosity. Another line is drawn perpendicular to the distal third of the first line. A third line is drawn from the dorsal iliac spine parallel to the midline, crossing the perpendicular line. The midway of the perpendicular line between the intersection of the cranial dorsal iliac spine and the ischiatic tuberosity is the approximate location of the sciatic nerve (needle). A line drawn from the distal ischiatic tuberosity to the sacrococcygeal joint is the approximate surface projection of the sacrotuberous ligament.</p